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Building Your Group Benefits Plan Part One - Health Coverage

Jan 29, 2018 3:45:00 PM

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When you think of group benefits plans, what most people think of first is health benefits. For most group benefits plans, health coverage is mandatory unless the plan member has coverage under another plan (i.e. through a spouse’s group benefits plan).

As this is the component that will make up the most of the costs of your benefits plan, let’s take a look at what the some of the different options for health coverage.

Prescription drug coverage is the most utilized benefit of any group benefits plan. Most plans will have an annual minimum that must be reached before offering 100% coverage for any drugs. Prior to reaching this minimum, the amount covered by the plan can vary from zero to 90%. To help manage costs more effectively, many plans will also have annual and/or lifetime maximums for this benefit.

Out of province/country coverage offers coverage for your employees and their families when they are travelling and experience a medical emergency with per person/per trip maximums.

Hearing aids, vision and orthotics coverage are also basic benefits included in most (but not all) group plans. These normally have coverage limits based on the benefit that will renew on a defined schedule. Typically, this is annually for orthotics, 24 months for vision and 60 months for hearing aids.

Hospital and private duty nursing options include semi-private or private hospital rooms should a plan member be hospitalized and annual maximums for private duty nursing.

The final component of the health coverage is paramedical practitioners. This is a popular aspect of many plans and could be a great option to make your plan more appealing to your employees. Types of services include massage therapy, naturopaths, nutritionists and physiotherapy.

Find out which style of benefits plan is right for you with our 2-step decision tool

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